<h2>Not a Qpid Affiliate yet? Register here !</h2>
<div class="form">

<?php $form=$this->beginWidget('CActiveForm', array(
	'id'=>'owner-form',
	'enableAjaxValidation'=>true,
	'clientOptions'=>array(
			'validateOnSubmit'=>true,
		)
)); 

?>

	<p class="note">Fields with <span class="required">*</span> are required.</p>

	<?php echo $form->errorSummary($owner); ?>
	<table>
		<tr>
			<th><?php echo $form->labelEx($owner,'firstname'); ?></th>
			<td>
				<?php echo $form->textField($owner,'firstname',array('size'=>20)); ?>
				<?php echo $form->error($owner,'firstname'); ?>
			</td>
		</tr>
		
		<tr>
			<th><?php echo $form->labelEx($owner,'lastname'); ?></th>
			<td>
				<?php echo $form->textField($owner,'lastname',array('size'=>20)); ?>
				<?php echo $form->error($owner,'lastname'); ?>
			</td>
		</tr>
			
		<tr>
			<th>
				<?php echo $form->labelEx($owner,'email'); ?>
			</th>
			<td>
				<?php echo $form->textField($owner,'email',array('size'=>20)); ?>
				<?php echo $form->error($owner,'email'); ?>
			</td>
		</tr>
	
		<tr>
			<th><?php echo $form->labelEx($owner,'passwd'); ?></th>
			<td>
				<?php echo $form->textField($owner,'passwd',array('size'=>20, "autocomplete" => "off")); ?>
				<?php echo $form->error($owner,'passwd'); ?>
			</td>
		</tr>
		
				
		<tr>
			<th><?php echo $form->labelEx($owner,'site'); ?></th>
			<td>
				<?php echo $form->textField($owner,'site',array('size'=>30)); ?>
				<?php echo $form->error($owner,'site'); ?>
			</td>
		</tr>
	
		<tr>
			<th><?php echo $form->labelEx($owner,'telephone'); ?></th>
			<td>
				<?php echo $form->textField($owner,'telephone',array('size'=>30)); ?>
				<?php echo $form->error($owner,'telephone'); ?>
			</td>
		</tr>
		
		<tr>
			<th><?php echo $form->labelEx($owner,'street'); ?></th>
			<td>
				<?php echo $form->textField($owner,'street',array('size'=>30)); ?>
				<?php echo $form->error($owner,'street'); ?>
			</td>
		</tr>
			
		<tr>
			<th><?php echo $form->labelEx($owner,'address'); ?></th>
			<td>
				<?php echo $form->textField($owner,'address',array('size'=>30)); ?>
				<?php echo $form->error($owner,'address'); ?>
			</td>
		</tr>
	
		<tr>
			<th><?php echo $form->labelEx($owner,'city'); ?></th>
			<td>
				<?php echo $form->textField($owner,'city',array('size'=>30)); ?>
				<?php echo $form->error($owner,'city'); ?>
			</td>
		</tr>
	
		<tr>
			<th><?php echo $form->labelEx($owner,'state'); ?></th>
			<td>
				<?php echo $form->textField($owner,'state',array('size'=>30)); ?>
				<?php echo $form->error($owner,'state'); ?>
			</td>
		</tr>
			
		<tr>
			<th><?php echo $form->labelEx($owner,'country'); ?></th>
			<td>
				<?php echo $form->textField($owner,'country',array('size'=>30)); ?>
				<?php echo $form->error($owner,'country'); ?>
			</td>
		</tr>
	
		
		<tr>
			<th><?php echo $form->labelEx($owner,'postcode'); ?></th>
			<td>
				<?php echo $form->textField($owner,'postcode',array('size'=>30)); ?>
				<?php echo $form->error($owner,'postcode'); ?>
			</td>
		</tr>
		
		<tr>
			<th></th>
			<td>
				<div class="row buttons">
					<?php echo CHtml::submitButton('Sign up'); ?>
				</div>
			</td>
		</tr>
	</table>

<?php $this->endWidget(); ?>

</div><!-- form -->